When injury to the liver is acute or liver damage is limited, the liver can usually repair itself. It is usually not short-term damage that causes cirrhosis, but repeated injury or damage occurring over many years that can lead to the development of cirrhosis. Causes are wide-ranging but generally fall into one of several categories:
- Alcoholic—excessive alcohol use over time can lead to alcoholic liver disease and cirrhosis.
- Associated with hepatitis, such as viral hepatitis, autoimmune hepatitis and non-alcoholic liver disease (NAFLD)
- Biliary—obstruction and/or damage to bile ducts
- Cardiac—congestive heart failure over time can cause liver damage and cirrhosis
- Metabolic or inherited—these include diseases such as cystic fibrosis, hemochromatosis, Wilson disease, Fanconi syndrome
- Drug-related (other than alcohol)
- Unknown—in about 10% of cases of cirrhosis, the cause is not known.
The frequency of these causes varies by population and geographic region. In the United States, about half of the cases of cirrhosis are caused by chronic hepatitis C infection and/or by chronic alcohol abuse (alcoholism). Chronic hepatitis B infection (sometimes with hepatitis D co-infection) causes a significant number of cases – and is one of the major causes in many parts of the world. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are significant non-infectious causes of cirrhosis, and the frequency of this cause is increasing while cases due to most other causes are remaining the same or decreasing.